Perianal fistülün tanısında, sınıflandırılmasında ve değerlendirilmesinde Manyetik Rezonans Görüntüleme’nin önemi

Abstract

Aim: Magnetic resonance imaging (MRI) is a non-invasive and high reliability procedure for evaluation of perianal area. In this study, our purpose is to present preoperative MRI findings and classification with images in diagnosed perianal fistula patients. Methods: Contrast enhanced (CE) conventional MRI images, diffusion weighted MRI images and demographics of 57 patients were retrospectively evaluated. Perianal fistula classification is based on St James University Hospital (SJUH) classification system. Results: 57 patients (44 men and 13 women, average of 18 to 72 years, average age of 45.7 year) were included in this study. Most of the patients had symptoms of rectal pain and discharge. Some patients had additional complaints like rectal itching, swelling and erythema. 37 patients had grade 1, nine patients had grade 2, four patients had grade 3, five patients had grade 4 and two patients had grade 5 fistula. Fistula opening positions into anal canal were 6 o'clock in 21 patients, 7 o'clock in 10 patients. Fistula tract, its opening position into anal canal, presence of abscess and its relationship with sphincters or neighboring anatomical structures were clearly appreciated with conventional and diffusion weighted MRI in all patients. Conclusion: Perianal fistula is the abnormal connection between anal canal and perinea. It is usually a complication of anorectal abscess. It could occur secondary to inflammatory processes like Crohn's disease, tuberculosis or malignancy. Surgery is considered as the primary treatment. Recurrence due to surgical inadequacy is common. Recurrence rates could be minimized with a good knowledge of MRI findings and well informing the surgeon.